Community College of Vermont—I-20 Application Form

Date___________________ Date of Birth________________

Student’s

First Name____________________________ Middle Initial___ Last Name________________________________

Current Address________________________________________________________________________________

(include Telephone Number)

International Address (if different)_________________________________________________________________

(required)

Email Address:________________________________________________________________________________

Country of Birth_____________________________ Country of Citizenship_______________________________

Passport Number________________________________ Expiration Date________________________________

Source of Financial

Support _____________________________________________________________________________________

Semester of First Enrollment_______________________Major at CCV__________________________________

CCV Site Where You Plan to Take Classes______________________ Advisor (if applicable)__________________

CCV Assessment or TOEFL Scores________________________________________________________________

If already in the United States: Type of Visa___________ Admission Number (from I-94)____________________

Expiration Date of Visa______________________

If you are transferring to CCV from another college in the U.S., write the name of that institution here:

_____________________________________________________________________________________________

Academic Transcripts sent from (Institution name)____________________________________________________

Please send this completed form to Maryellen Lowe, International Student Liaison, l42 South Main Street,

St. Albans, VT 05478. You should attach a current bank statement showing available funds in the amount of $17,500US (and the Affidavit of Support by a Sponsor, if applicable, with a bank statement included) and a copy of your TOEFL scores.

A note to advisors: an international student with a student visa must be enrolled as a full-time degree student and pay non-resident tuition.

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